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General NPI Number Information
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NPI Number | 1679623631
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Entity Type | Organization
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Legal Business Name | HEARTLAND DIGESTIVE DISEASE CENTER, LLC
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Dates
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Enumeration Date | 01/11/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2406 RING RD
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City | ELIZABETHTOWN
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State | KY
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Zip | 42701-7940
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Country | US
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Telephone | 270-234-8866
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Fax | 270-234-1355
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Provider Business Mailing Address
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Address Line | 2406 RING RD
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City | ELIZABETHTOWN
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State | KY
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Zip | 42701-7940
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Country | US
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Telephone | 270-234-8866
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Fax | 270-234-1355
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Authorized Official
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Title or Position | PRESIDENT
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Name | KASHIF B HAIDER
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Credential | MD
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Telephone | 270-234-8866
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number |
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License Number State | KY
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